Fracture risk assessment in clinical practice: T-scores, FRAX, and beyond

Assessment of fracture risk is a key component in the evaluation of skeletal health and a critical step in determining whether to initiate pharmacological therapy to reduce fracture risk. The identification of high risk patients allows clinicians to direct limited healthcare resources to those who are most likely to benefit. Bone mineral density (BMD) and clinical risk factors (CRFs) for fracture predict fracture risk better than BMD or CRFs alone. Dual-energy X-ray absorptiometry (DXA) is a technology for the measurement of BMD to diagnose osteoporosis, assess fracture risk, and monitor the BMD response to therapy. Validated CRFs and femoral neck BMD by DXA, when available, provide the input for the World Health Organization fracture risk assessment tool (FRAX) to estimate the 10-year probability of fracture in untreated patients. Economic models have included FRAX in calculations to estimate when pharmacological intervention is likely to be cost-effective in reducing fracture risk. Cost-effectiveness is one of many factors to consider in making treatment decisions. This is a review of the benefits and limitations of BMD testing, CRFs, and FRAX in the management of patients in clinical practice. © 2009 Humana Press Inc.